Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND623 | CA |
NPI | 1134412745 |
---|---|
Provider Name | Ms. Sophanary Lorn |
First Address | Santa Rosa, CA 95404-3568 |
Second Address | Santa Rosa, CA 95404-3568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 14/03/2014 |